Nursing workload in public and private intensive care
               units

This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in São Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patient's stay at the intensive care unit. Pearson's chi-square test, Fisher's exact test, the Mann-Whitney test, and Student's t test were used to compare the patient groups.

RESULTS:

The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the "care of drains", "mobilization and positioning", and "intravenous hyperalimentation". The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit.

CONCLUSION:

Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning.

Workload; Nursing staff, hospital; Hospitals, private/manpower; Hospitals, public/manpower; Intensive care units

Variables	Institution type				p value
	Public		Private
	Mean	Median	Mean	Median
	(SD)	(Variation)	(SD)	(Variation)
NAS admission	68.1	61.4	56.0	53.6	<0.001
NAS admission	(24.5)	(28.2-138.4)	(16.1)	(25.6-122.5)	<0.001
NAS discharge	54.7	52.3	51.0	49.3	0.10
NAS discharge	(16.4)	(8.4-119.8)	(15.1)	(14.1-116.5)	0.10

Type of intervention - admission		Institution type		p value
	Categories	Public	Private
	Categories	N (%)	N (%)
1. Monitoring and titration	1a	113 (39.2)	181 (61.6)	<0.001
1. Monitoring and titration	1b and c	175 (60.8)	113 (38.4)
2. Laboratory investigations	Y	287 (99.7)	294 (100.0)	0.49
2. Laboratory investigations	N	1 (0.3)	-
3. Medication	Y	286 (99.3)	294 (100.0)	0.24
3. Medication	N	2 (0.7)	-
4. Hygiene procedures	4a	233 (80.9)	225 (76.5)	0.20
4. Hygiene procedures	4b and c	55 (19.1)	69 (23.5)
5. Care of drains	Y	134 (46.5)	239 (81.3)	<0.001
5. Care of drains	N	154 (53.5)	55 (18.7)
6. Mobilization and positioning	6a	155 (53.8)	118 (40.1)	<0.001
6. Mobilization and positioning	6b and c	133 (46.2)	176 (59.9)
7. Support and care of relatives and patient	7a	253 (87.9)	291 (99.0)	<0.001-
7. Support and care of relatives and patient	7b	35 (12.1)	3 (1.0)
8. Administrative and managerial tasks	8a	161 (55.9)	247 (84.0)	<0.001
8. Administrative and managerial tasks	8b and c	127 (44.1)	47 (16.0)
9. Respiratory support	Y	238 (82.6)	198 (67.4)	<0.001
9. Respiratory support	N	50 (17.4)	96 (32.6)
10. Care of artificial airways	Y	109 (37.9)	105 (35.7)	0.59
10. Care of artificial airways	N	179 (62.1)	189 (64.3)
11. Treatment for improving lung function	Y	145 (50.4)	60 (20.4)	<0.001
11. Treatment for improving lung function	N	143 (49.6)	234 (79.6)
12. Vasoactive medication	Y	91	85	0.48
12. Vasoactive medication	N	197	209
13. Intravenous replacement of large fluid losses	Y	50	2	<0.001
13. Intravenous replacement of large fluid losses	N	238	292
14. Left atrium monitoring	Y	2	7	0.10
14. Left atrium monitoring	N	286	287
15. Cardiopulmonary resuscitation	Y	5	2	0.28
15. Cardiopulmonary resuscitation	N	283	292
16. Hemofiltration techniques	Y	14	24	0.11
16. Hemofiltration techniques	N	274	270
17. Quantitative urine output measurement	Y	266	279	0.21
17. Quantitative urine output measurement	N	22	15
18. Measurement of intracranial pressure	Y	4	9	0.17
18. Measurement of intracranial pressure	N	284	285
19. Treatment of complicated metabolic acidosis/alkalosis	Y	13	-	<0.001
19. Treatment of complicated metabolic acidosis/alkalosis	N	275	294
20. Intravenous hyperalimentation	Y	9	27	<0.001
20. Intravenous hyperalimentation	N	279	267
21. Enteral feeding	Y	62	80	0.11
21. Enteral feeding	N	226	214
22. Specific interventions in the intensive care unit	Y	36	12	<0.001
22. Specific interventions in the intensive care unit	N	252	282
23. Specific interventions outside the intensive care unit	Y	26	1	<0.001
23. Specific interventions outside the intensive care unit	N	262	293

NAS evolution	Institution type				p value
	Public		Private
	Mean	Median	Mean	Median
	(SD)	(Variation)	(SD)	(Variation)
NAS (survivors and non-survivors)	+13.3	+6.8	+5.0	+1.5	<0.001
NAS (survivors and non-survivors)	(24.2)	(-51.8/+83.2)	(16.9)	(-64.4/+69.9)	<0.001
NAS (survivors)	+17.9	+10.6	+6.3	+1.8	<0.001
NAS (survivors)	(23.5)	(-38.3/+83.2)	(15.8)	(-64.4/+69.9)	<0.001
NAS (non-survivors)	-0.1	-1.4	-2.8	0.0	0.51
NAS (non-survivors)	(21.1)	(-51.8/+55.3)	(21.1)	(-64.1/+47.4)	0.51

Associação de Medicina Intensiva Brasileira - AMIB Rua Arminda, 93 - Vila Olímpia, CEP 04545-100 - São Paulo - SP - Brasil, Tel.: (11) 5089-2642 - São Paulo - SP - Brazil
E-mail: rbti.artigos@amib.com.br

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[1] Corresponding author: Lilia de Souza Nogueira, Escola de Enfermagem da Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 419, Zip code: 05403-000 - São Paulo (SP), Brazil, E-mail: lilianogueira@usp.br